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78109859 High Alert Medications

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Institute for Safe
Medication Practices
www.ismp.org
Institute for Safe Medication Practices
Classes/Categories of Medications
adrenergic agonists, IV (e.g., epinephrine, phenylephrine, norepinephrine)
adrenergic antagonists, IV (e.g., propranolol, metoprolol, labetalol)
anesthetic agents, general, inhaled and IV (e.g., propofol, ketamine)
antiarrhythmics, IV (e.g., lidocaine, amiodarone)
antithrombotic agents (anticoagulants), including warfarin, low-molecular-weight
heparin, IV unfractionated heparin, Factor Xa inhibitors (fondaparinux), direct
thrombin inhibitors (e.g., argatroban, lepirudin, bivalirudin), thrombolytics (e.g.,
alteplase, reteplase, tenecteplase), and glycoprotein IIb/IIIa inhibitors (e.g., eptifi-
batide)
cardioplegic solutions
chemotherapeutic agents, parenteral and oral
dextrose, hypertonic, 20% or greater
dialysis solutions, peritoneal and hemodialysis
epidural or intrathecal medications
hypoglycemics, oral
inotropic medications, IV (e.g., digoxin, milrinone)
liposomal forms of drugs (e.g., liposomal amphotericin B)
moderate sedation agents, IV (e.g., midazolam)
moderate sedation agents, oral, for children (e.g., chloral hydrate)
narcotics/opiates, IV, transdermal, and oral (including liquid concentrates, immediate
and sustained-release formulations)
neuromuscular blocking agents (e.g., succinylcholine, rocuronium, vecuronium)
radiocontrast agents, IV
total parenteral nutrition solutions
ISMP’s List of High-Alert Medications
igh-alert medications are drugs that bear a heightened risk of
causing significant patient harm when they are used in error.
Although mistakes may or may not be more common with these
drugs, the consequences of an error are clearly more devastating to
patients. We hope you will use this list to determine which medica-
tions require special safeguards to reduce the risk of errors. This
may include strategies like improving access to information about
these drugs; limiting access to high-alert medications; using
auxiliary labels and automated alerts; standardizing the ordering,
storage, preparation, and administration of these products; and
employing redundancies such as automated or independent double-
checks when necessary. (Note: manual independent double-checks
are not always the optimal error-reduction strategy and may not be
practical for all of the medications on the list).
Specific Medications
colchicine injection***
epoprostenol (Flolan), IV
insulin, subcutaneous and IV
magnesium sulfate injection
methotrexate, oral, non-oncologic use
opium tincture
oxytocin, IV
nitroprusside sodium for injection
potassium chloride for injection concentrate
potassium phosphates injection
promethazine, IV
sodium chloride for injection, hypertonic (greater than 0.9% concentration)
sterile water for injection, inhalation, and irrigation
(excluding pour bottles) in containers of 100 mL or more
Background
Based on error reports submitted to the USP-ISMP Medication Errors Reporting
Program, reports of harmful errors in the literature, and input from practitioners and
safety experts, ISMP created and periodically updates a list of potential high-alert
medications. During February-April 2007, 770 practitioners responded to an ISMP
survey designed to identify which medications were most frequently considered
high-alert drugs by individuals and organizations. Further, to assure relevance and
completeness, the clinical staff at ISMP, members of our advisory board, and safety
experts throughout the US were asked to review the potential list. This list of drugs
and drug categories reflects the collective thinking of all who provided input.
H
© ISMP 2008. Permission is granted to reproduce material for internal newsletters or communications with proper attribution. Other
reproduction is prohibited without written permission. Unless noted, reports were received through the USP-ISMP Medication Errors
Reporting Program (MERP). Report actual and potential medication errors to the MERP via the web at www.ismp.org or by calling
1-800-FAIL-SAF(E). ISMP guarantees confidentiality of information received and respects reporters’ wishes as to the level of detail
included in publications.
©

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***Although colchicine injection should no longer be used, it will remain on the list until
shipments of unapproved colchicine injection cease in August 2008. For details,
please visit: www.fda.gov/bbs/topics/NEWS/2008/NEW01791.html.

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